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Pathologic Gait Patterns
Pathologic gait patterns can be broadly divided into either neuromuscular or musculoskeletal etiologies. Gait deviations may result from structural abnormalities of a bone, joint, or soft tissue. Other causes of pathologic gait include neuromuscular and myopathic conditions. http://www.rehab.research.va.gov/mono/gait/malanga.pdf Common Musculoskeletal causes http://www.rehab.research.va.gov/mono/gait/malanga.pdf *Knee pathology *Foot and ankle pathology *Leg length discrepancy Common neurologic causes http://www.rehab.research.va.gov/mono/gait/malanga.pdf *Cerebrovascular conditions *Central nervous system conditions *Cerebellar conditions Common motor weakness causes http://www.rehab.research.va.gov/mono/gait/malanga.pdf *Hip extensor weakness *Hip flexor weakness *Quadriceps weakness *Ankle dorsiflexor weakness *Triceps surae weakness Antalgic Gait Causes *Pain in limb Characteristics A limping gait, indicative of pain upon weight bearing. The stance phase is significantly shortened relative to the swing phase to minimize closed chain loading and reduce pain. http://en.wikipedia.org/wiki/Antalgic_gait Ataxic Gait Causes *Injury to the cerebellum *Sensory deficits in lower limb Characteristics An unsteady, uncoordinated walk with a broad standing base. Movements appear exaggerated, leg placement is variable and reproducibility is lost. http://www.rehab.research.va.gov/mono/gait/malanga.pdf Choreiform (Hyperkinetic) Gait Causes http://stanfordmedicine25.stanford.edu/the25/gait.html *Sydenham's chorea *Huntington's disease *Athetosis *Dystonia Characteristics Irregular, jerky, and involuntary movements occur in all extremities. Walking may accentuate the baseline movement disorder. http://stanfordmedicine25.stanford.edu/the25/gait.html Diplegic Gait Causes *Cerebral Palsy Characteristics Bilateral involvement and spasticity in all extremities. Patient will walk with an abnormally narrow base, dragging both legs and scraping the toes. Adductor tightness may cause legs to scissor. http://stanfordmedicine25.stanford.edu/the25/gait.html Drop Foot Causes *Weak dorsiflexors *Paralyzed dorsiflexors *Damaged common fibular nerve Characteristics Gait in which the forefoot cannot be actively raised. The advancing leg is lifted high in order to clear the toes and in some cases the foot may audibly slap the ground due to lack of eccentric dorsiflexion. http://en.wikipedia.org/wiki/Foot_drop Gluteus Maximus (Lurch) Gait Causes *Hip extensor weakness, gluteus maximus weakness, knee ankylosis and spasticity or orthotic knee lock http://www.rehab.research.va.gov/mono/gait/malanga.pdf Characteristics A backward trunk lurch persists throughout stance phase to maintain center of mass behind the hip axis, locking the hip in extension. The hamstring muscles may compensate in some cases. http://www.rehab.research.va.gov/mono/gait/malanga.pdf Trendelenburg Gait Causes *Hip abductor weakness http://www.rehab.research.va.gov/mono/gait/malanga.pdf Characteristics *If uncompensated, during stance phase on the affected side there is a drop in the pelvis on the unaffected side greater than the normal 5 degrees (Trendelenburg sign). There is also a lateral protrusion of the affected hip. http://www.rehab.research.va.gov/mono/gait/malanga.pdf *If compensated, there is a lateral trunk lurch over the affected hip during stance phase. This maintains the center of gravity over the hip, reducing the muscle force required to stabilize the trunk and pelvis. http://www.rehab.research.va.gov/mono/gait/malanga.pdf Hemiplegic Gait Causes *Cerebrovascular accident http://stanfordmedicine25.stanford.edu/the25/gait.html Characteristics Patient has unilateral weakness on affected side, with leg in extension and foot plantarflexed. During swing phase, affected limb circumducts to clear ground due to foot drop and extensor hypertonia in the lower limb. http://stanfordmedicine25.stanford.edu/the25/gait.html Parkinsonian (Festinating) Gait Causes *Parkinson's Disease *Other disorders of the basal ganglia http://en.wikipedia.org/wiki/Hypokinesia Characteristics Patient presents observable bradykinesia, tremor, and rigidity. http://en.wikipedia.org/wiki/Bradykinesia#Bradykinesia Gait consists of many small, shuffling steps also known as marche a petis pas. There may be difficulty initiating steps and once moving there may be an involuntary inclination to increase cadence, which is known as festination. http://stanfordmedicine25.stanford.edu/the25/gait.html References